This project is part of a four-phase effort titled "Internet Linking of Northeast Michigan Health Services." In Phase I, Alpena General Hospital completed its Intranet infrastructure, established frame relay connectivity to three of its own satellite services, installed a firewall for security, and will complete Internet connectivity by 12/98 and training by 6/99. This proposal covers Phase II, in which Thunder Bay Health Services? two sites and Alcona Health Services? four sites will be linked by Permanent Virtual Circuits (PVCs) to each other and, by frame relay, to Alpena General Hospital?s Intranet, through which they will gain secure access to the Internet. In Phases III and IV, 39 physicians in private practice at 18 sites will be linked to this network. Thunder Bay Health Services and Alcona Health Services, both Federally Qualified Health Centers (FQHCs), are the only providers of non-acute primary health care services in three counties of a six-county region of rural Northeast Michigan. This region has a population of 100,000 and covers 3,567 square miles, an area larger than the states of Rhode Island and Delaware combined. It is served by Alpena General Hospital, a regional referral center and the only hospital in the region since the closure of three hospitals in the past ten years. These closures and a population that is elderly and growing have resulted in an increase in demand for services. The health centers have added remote sites and additional physicians to increase access. Thunder Bay has two sites and Alcona has four sites. It is the mutual objective of these facilities to strengthen the entire regional medical system by establishing a frame relay network with Internet connectivity at all sites through Alpena General Hospital to: 1) gain access to medical databases and the National Library of Medicine?s resources 2) share and exchange medical information, 3) improve access to patient care, 4) provide access to Continuing Medical Education programming, and 5) reduce costs of providing care. This will enable gradual integration of medical services region wide to achieve improved access to medical information, as well cost efficiencies and economies of scale through coordination of services, systems, expertise, and space.